X12 Ingest & Denial Analytics

Demo Environment — Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.
Members›policy B10M000350›OMAR GARCIA

OMAR GARCIA

Subscriber on policy B10M000350

Claims
2
Attributed to this person
Charged
931.00
Total submitted
Denied
39.95
1 denied claims
Patient responsibility
0.00
Reported on the 835

Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.

Who this is

FieldValue
NameOMAR GARCIA
Role on the policySubscriber
PolicyB10M000350
Date of birth27 Mar 1978
PlanSILVER HMO
Covered from5 Feb 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000145916 Sep 2025798.00MERIDIAN HEALTH PLANNot denied—
CLM00014608 Apr 2025133.00MERIDIAN HEALTH PLANCARC 50 · MEDICAL_NECESSITY39.95